NDM-1 CARRYING ENTEROBACTERIACEAE - INDIA (02): NOSOCOMIAL INFECTIONS
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A ProMED-mail post
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International Society for Infectious Diseases
[1] Neonatal ICU
Date: Wed 5 Oct 2011
Source: IBN Live [edited]
India is hosting a global summit on antibiotic resistance in New Delhi
this week [week of 3 Oct 2011], even as the NDM-1 bacterial resistance
factor has now made its way into neonatal ICUs in the country and is
affecting and killing newborn babies.
Because of antibiotic resistance, nearly 60 000 newborn babies are
dying every year in India of sepsis, a treatable blood infection,
despite getting lifesaving antibiotics. "The organisms in the
hospitals have become multidrug resistant. Even the strongest
antibiotics may not work. Invariably, the baby ends up losing the
battle," said Dr Vishal Singh, Sr Consultant, Pediatric Critical Care
Unit, Neonatal ICU.
According to the Public Health foundation of India, one million babies
die every year in India within the 1st 4 weeks of birth, and 190 000
are dying of sepsis, often due to lack of access to medicines, and 30
percent of these deaths are due to antibiotic resistant bacteria.
There is now the threat from NDM-1 containing bacteria, as 4 infants
at a hospital in Birbhum district in rural West Bengal affected with
these bacteria died within 72 hours.
"When we abuse antibiotics or don't use them appropriately, we are
basically strengthening the bacteria that work against these babies,"
said Dr Ramanan of PHFI. "To change this, all we need to do is to use
antibiotics according to prescribed guidelines.
--
Communicated by:
ProMED-mail Rapporteur Mary Marshall
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[2] General hospital
Date: Wed 5 Oct 2011
Source: India Today [edited]
A study conducted at Delhi's famous Sir Ganga Ram Hospital has found a
worryingly high prevalence of bacteria containing a resistance factor
gene named New Delhi metallo-beta-lactamase 1 (NDM-1). The study,
conducted over the last 5 months, found patients positive for bacteria
containing the antibiotic drug-resistance factor.
A total of 10 889 samples were collected from the hospital. Out of
these, over 2500 positive samples were found in the intensive care
unit (ICU) and around 2700 more in the general ward. The positive
samples came mostly from patients with _E. coli_ infection and
pneumonia. However, doctors at the hospital said that since Ganga Ram
was a tertiary care hospital, patients could already have been
infected when they came to the hospital.
Senior physician and cardiologist Dr K.K. Aggarwal said: "The bacteria
are present. There are 3 studies now which confirm that [they are]
present in the hospitals; they are present in multiple hospitals,
present in India. They are present in water. Now, Ganga Ram says they
are present in their ward. It's a matter of serious concern. All
hospitals should check it, should come out with a new antibiotic
policy, and should absolutely implement hygiene maintenance," Aggarwal
added.
--
Communicated by:
ProMED Rapporteur Mary Marshall
[Originating in India, NDM-1 containing bacteria have spread to the
developed world. As reported in the 25 Jun 2010 Morbidity and
Mortality Weekly Report (2010;59:750), during the 1st half of 2010, 3
isolates of _Enterobacteriaceae_, an _E. coli_, a _Klebsiella
pneumoniae_, and an _Enterobacter cloacae_, were identified at CDC to
carry NDM-1, which confers resistance to all beta-lactams except
aztreonam (a monobactam) and were also resistant to aztreonam. All 3
isolates were from patients who received recent medical care in
India.
Yong and colleagues (Yong D, Toleman MA, Giske CG, et al:
Characterization of a new metallo-beta-lactamase gene, bla-NCm-1, and
novel erythromycin esterase gene carried on a unique genetic structure
in _Klebsiella pneumoniae_ sequence type 14 from India. Antimicrob
Agents Chemother. 2009;53: 5046-54) found that the plasmid carrying
NDM-1 also carries several other resistance genes and appears to
easily transmit itself to other organisms. The authors state that "the
dissemination of this plasmid among clinical bacteria would be a
nightmare scenario."
This NDM-1 gene cassette of wide-spectrum antimicrobial resistance
appears to have developed in the Indian subcontinent, as in the above
report, where the use of antimicrobial agents is quite poorly
controlled. Organisms carrying this resistance combination have
already been introduced into western Europe, the USA, and Canada. The
best methods of control are rapid recognition by standard
microbiologic methodology in patients having the appropriate
medical/travel history and aggressive hand washing techniques.
The amazing overuse of our current antimicrobial armamentarium that I
am currently observing in my clinical practice in the USA will no
doubt serve as an efficient multiplier of these isolates, just as
intravenous drug abuse and sexual promiscuity facilitated the
explosion of HIV 30 years ago. This misuse, in my opinion, is directly
related to the lack of control of antimicrobial usage in intensive
care units and emergency care settings by intensivists and ER
physicians who often react with a lack of wisdom and "cookbook"
protocols instead of using common sense and rational prescribing
patterns. Once the patient moves out of the ICU or ER, the physicians
do not even see the products of their unwise labors.
In the USA, reimbursements for medical care are based on procedures,
not thought processes. Until the power of therapeutic nihilism is
recognized -- that is, using these agents only when rational, in
combinations that make sense, and in settings where therapeutic
interventions can have the ability to produce measurable and
meaningful improvement in a patient's life -- the medical community
will continue down the slippery slope into an era where no therapeutic
options will exist. - Mod.LL]
[see also:
NDM-1 carrying Enterobacteriaceae - India, China: govt. response
20110412.1156
NDM-1 carrying Enterobacteriaceae - India: (New Delhi) water supply
20110411.1145
2010
----
Gram negative bacilli, resistant, update (01): NDM-1, KPC
20101028.3908
NDM-1 carrying Enterobacteriaceae (04): Taiwan ex India 20101005.3604
VIM carrying Enterobacteriaceae - USA ex Greece: 1st rep.
20100922.3422
NDM-1 carrying Enterobacteriaceae (03): worldwide ex India, Pakistan
20100914.3325
NDM-1 carrying Enterobacteriaceae (02): worldwide ex India, Pakistan
20100817.2853
NDM-1 carrying Enterobacteriaceae: N America, UK ex India
20100815.2812]
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